An Official American Thoracic Society Workshop Report: Presentations and Discussion of the Sixth Jack Pepys Workshop on Asthma in the Workplace

Abstract

The Sixth Jack Pepys Workshop on Asthma in the Workplace focused on six key themes regarding the recognition and assessment of work-related asthma and airway diseases: (1) cleaning agents and disinfectants (including in swimming pools) as irritants and sensitizers: how to evaluate types of bronchial reactions and reduce risks; (2) population-based studies of occupational obstructive diseases: use of databanks, advantages and pitfalls, what strategies to deal with biases and confounding?; (3) damp environments, dilapidated buildings, recycling processes, and molds, an increasing problem: mechanisms, how to assess causality and diagnosis; (4) diagnosis of occupational asthma and rhinitis: how useful are recombinant allergens (component-resolved diagnosis), metabolomics, and other new tests?; (5) how does exposure to gas, dust, and fumes enhance sensitization and asthma?; and (6) how to determine probability of occupational causality in chronic obstructive pulmonary disease: epidemiological and clinical, confirmation, and compensation aspects. A summary of the presentations and discussion is provided in this proceedings document. Increased knowledge has been gained in each topic over the past few years, but there remain aspects of controversy and uncertainty requiring further research.

Serum but not exhaled breath condensate periostin level is increased in competitive athletes

“…As a consequence, the exercise stimulus that is provided may be by far not sufficient to cause bronchoconstriction. Moreover, the treadmill exercise environment lacks irritants and allergens that may be contained in the air breathed at the swimming pools …”

“…Moreover, the treadmill exercise environment lacks irritants and allergens that may be contained in the air breathed at the swimming pools. 24,25 Increased periostin has been associated with fixed airway obstruction and faster lung function decline. 6 It has been proven that the deterioration of lung function in athletes may be reversible, but worsens progressively in those who continue to exercise.…”

Association between Work and Chronic Obstructive Pulmonary Disease (COPD)

“…From a pathological point of view, smoking is part of VGDF and therefore a confounder in the association between work and COPD. Smoking and VGDF at work have a synergistic effect on COPD, however VGDF without smoking shows attributable risk estimates between 27–53% [11]. So, for individual smoking and non-smoking workers VGDF at work increase the likelihood of COPD [11].…”

“…The knowledge about the role of occupational exposures in the development of COPD has not been without controversy [10] and is under debate in various national occupational compensation schemes for occupational diseases [11]. An overview of systematic reviews, summarizing evidence of pooled estimates of associations between vapors, dusts, gases, and fumes (VDGF) and COPD is lacking for the clinical and occupational health care setting.…”

Addressing Molecular Diagnosis of Occupational Allergies

“…Sensitizer-induced occupational asthma (OA) and rhinitis (OR) are associated with a substantial public health burden because of their high prevalence and socio-economic impacts [ 1 , 2 •]. More than 400 occupational agents are currently documented in the scientific literature as being potential “respiratory sensitizers” [ 3 , 4 , 5 ••]. These agents that may induce OR or OA can be categorized into high-molecular-weight (HMW) and low-molecular-weight (LMW) agents.…”